NEW ORLEANS — A large retrospective cohort study revealed that GLP-1 receptor agonists did not significantly alter the frequency of anti-VEGF treatments in patients suffering from diabetic macular edema (DME).
Over a follow-up period of 24 months, there was “no sustained or progressive change” in anti-VEGF treatments after patients began GLP-1 agonist therapy compared to those who did not initiate such treatment. Additionally, there were no significant changes in visual acuity and retinal thickness, which are critical outcomes in DME management.
The findings, described as “clinically neutral,” contribute to earlier studies indicating that GLP-1 drugs may have varying effects on the risk for DME. This was reported by Preeti Nagalamadaka, a medical student from Warren Alpert Medical School at Brown University, during a presentation at the American Academy of Ophthalmology (AAO) meeting.
“This adds to the understanding since we are focusing on patients already diagnosed with DME,” she stated. “Management of DME should continue to be directed by ocular disease activity and responses to anti-VEGF treatments. The current study offers reassuring insights amid ongoing debates about the ocular safety of GLP-1 receptor agonists. Future research should delve deeper into the ocular implications of GLP-1 receptor agonists.”
Regarding varying DME severity, Nagalamadaka noted that this variable was accounted for in propensity matching, but additional future studies will analyze this factor more thoroughly.
Data Analysis Challenges
Jennifer Sun, MD, MPH, from Harvard Medical School, highlighted that studies relying on large datasets often face challenges when narrowing down to selected cohorts that may not be easily generalizable. The study eventually analyzed 10,000 matched pairs, starting from a much larger cohort of patients.
“There are millions of patients in the IRIS database,” said Nagalamadaka. “Initially, we started with hundreds of thousands diagnosed with DME who underwent anti-VEGF treatments, but we had stringent inclusion and exclusion criteria that narrowed the population significantly.”
Further questions arose concerning the pretreatment follow-up period for patients who did not receive GLP-1 receptor agonists. Nagalamadaka clarified that those starting GLP-1 treatment were compared to control patients diagnosed with DME during the same timeframe.
Other studies presented emphasized ongoing interest in the relationship between GLP-1 drugs and ocular conditions. One study initially indicated a potentially increased risk of age-related macular degeneration (AMD) in patients on GLP-1 agonists; however, after further adjustment, the data suggested a likely reduction in AMD risk. Two studies on anterior ischemic optic neuropathy (AION) showed an occurrence at a younger age among GLP-1 agonist users, demonstrating a greater risk for subsequent events in these patients.
Previous investigations into GLP-1 receptor agonists and DME primarily targeted disease incidence. Limited research exists concerning the association between these medications and the treatment burden for DME patients. The recent study retrospectively examined data from two propensity-matched groups of 9,896 individuals with DME, estimating the frequency of monthly anti-VEGF injections.
The primary aim was to assess whether GLP-1 agonist therapy influenced the frequency of anti-VEGF injections, particularly with a focus on reducing treatment burden.
The findings indicated no significant changes in injection frequency for either cohort over the 36-month period analyzed.
Exploring AMD and AION Relationships
Recent studies have also scrutinized the links between GLP-1 receptor agonist usage and AMD, revealing inconsistent outcomes. Adjusting for various confounders, including diabetes status and AMD subtype, may enhance future data evaluations. Ruan, a medical student at Carle Illinois College of Medicine, emphasized this point.
Using the Epic Cosmos electronic health database, the researchers encountered 15 million GLP-1 receptor agonist users, of which 1.4 million had AMD, identifying 115,056 GLP-1 users with AMD.
Initial analysis suggested an increased odds ratio for AMD among GLP-1 users; however, adjustments for different conditions altered these results, in some cases indicating a decreased risk.
Using similar data, investigations also focused on AION cases, finding that the average onset age for AION was lower in GLP-1 users compared to non-users. Among GLP-1 users, AION typically occurred at about 63 years, in contrast to around 66 years for non-users.
The findings underscore the necessity for clinicians to remain vigilant when treating patients with a history of AION, particularly those on GLP-1 receptor agonists.
Importantly, while the study highlights associations, it does not imply causation. The therapeutic advantages of GLP-1 receptor agonists for managing diabetes, obesity, and cardiovascular issues remain critical considerations.
**Disclaimer**: This content is intended for informational purposes only and should not be considered medical advice. Always consult with a healthcare professional for specific medical-related inquiries.
Fuente: https://www.medpagetoday.com/meetingcoverage/aao/123385
Join the doctors who get the most relevant medical news, curated by specialty, every week — no spam, unsubscribe anytime.
